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August 18, 2008

Hospital Honors Its Navajo Ties

by Sam Savage

By Angela Haupt

When a Navajo woman delivers a baby at Banner Page Hospital in northern Arizona, she invites her entire family -- often more than 10 people -- into the birthing room. She may give birth squatting, as is custom among Native Americans. A medicine man will offer ancient prayers and herbs for the mother to ease childbirth. After the baby is delivered, nurses will save the placenta so the family can take it home and bury it in a sacred place.

In this desert town flanked by canyons and Lake Powell, traditional Navajo healing is merging with modern medicine. The hospital's Native American Cultural Committee, formed in 2002, is working toward an inclusive medical community by tackling the cultural sensitivities of the Navajo people, many of whom are wary of modern medicine.

Communication is key

"Twenty, 30 years ago, it was as if the community put up with the fact that we were living on the border of a Navajo reservation," says committee head Lisa Martin. "Now, this hospital and staff has a good understanding of the Navajo tradition and what it takes to heal. You have to consider the entire person, family and culture."

The 25-bed facility in rural Page, Ariz., serves a population of about 20,000 drawn from a 50-mile radius. About 50% of patients come from the nearby Navajo reservation, says Banner Page CEO Sandy Haryasz.

Hospitals have long struggled with providing health care to Native Americans, who often don't trust modern medicine and techniques. That distrust is exacerbated by a lack of understanding, Martin says. The Navajo language does not have terms for many body parts and conditions, which makes it difficult for doctors and patients to communicate.

A group of Navajo-speaking staff members underwent a six-week medical interpretation program to learn how to convey medical terms to patients.

"The Navajo way of describing body parts is to use sheep, the main meat source on the reservation," Martin says. "We've provided a lot of education on body parts and how they can be explained. Our staff jumped right in there."

In January, Banner Page completed a new 10,000-square-foot emergency department, patient registration area and hospital entrance. The renovated area follows a round, curved design, and the entrance faces the east, where the Navajo believe life originates.

Before unveiling the renovated emergency department, the hospital held a traditional Navajo blessing ceremony with a medicine man.

"They need that to feel safe," Haryasz says. "It's easier for them to come in and accept Western medicine if they know the bad spirits are gone, that the building is blessed."

Perhaps the most visible of the committee's accomplishments is an on-site Hogan, a traditional Navajo dwelling place used for ceremonial purposes. It is an eight-sided log structure with a skylight opening where medicine men can create fires. Ceremonies often are held when patients are close to death, says Esther Tsinigine, a Navajo who works in the hospital's lab.

But a medicine man's influence stretches beyond the Hogan and into the halls of the hospital, where he guides physicians and helps patients feel more tied to their cultural beliefs.

"Medicine men have that gift: They know what should be done and how," Tsinigine says. "And that's (Native Americans') idea of what has to happen, what to do if something goes wrong. You need to call in the medicine man."

Respect displayed in details

Much of the hospital's efforts have focused on educating its staff. Nurses should ask before removing smudges from patients' faces, for instance, because they could be ceremonial marks. To demonstrate respect, Navajos should be greeted with a handshake and "hello" -- though it is customary for them to avoid looking others in the eye.

It's also important to ask patients what their final wishes are delicately, because Native Americans fear such a question could invite death, Haryasz says.

The committee has reshaped its food services program to offer traditional foods such as Navajo tea, mutton stew and corn mush, and the hospital offers a kitchen where patients and visitors can cook their own meals.

Although no hard data exist to measure the Cultural Committee's effectiveness, staff members agree it has enhanced the hospital. Says Haryasz, "Many of our patients have told us they're very pleased with how we honor their cultural diversity and how we respect and provide what they need to have a healing experience."